Siriraj Medical Journal

82-91

Authors: Vimolluck Sanansilp, M.D., Petchara Boonsang, B.N.S., B.P.H., Sunee Thongtanee, B.N.S., M.A., Rattana Pernchareonsin, B.N.S., M.N.S., Tidawun Chaimanee, B.N.S., M.Sc., Varaluk Boonchai, B.N.S., Muntana Charoenloet, B.N.S., B.Ed., Benjawan Kongmuang, B.N.S., Suppat Petcharatana, B.N.S., Nongyao Kumvijitraporn, B.N.S., Taworn Detpetch, B.N.S., Ampun Netphisuth, B.Sc., Piengchai Vichaidith, B.N.S.

Objective: To determine the current postoperative pain status in the postanesthesia care unit (PACU) and nursing practices that may affect pain relief outcomes. Methods: We performed a prospective observational study in 259 postsurgical patients who underwent general anesthesia only, and were admitted to 5 PACUs in Siriraj Hospital during of cial work hours. We silently observed the pattern of nursing management for postoperative pain according to the hospital work instructions (WIs). We interviewed the patients once about their pain scores (PSs) at the time they were discharged to wards. The man- power in each PACU was determined. All nurses working in 5 PACUs were asked to ll in the questionnaire. Results: The PS after gaining consciousness, the overall PS, and the PS at discharge time were (mean±SD) 1.3±2.9, 4.1±2.7 and 3.1±2.4, respectively. The time to re-evaluate PS after each intravenous analgesic, to determine the adequacy of treatment, was longer than was recommended, so were the time of giving the additional doses which were 21.9±16.7 minutes, and 20.9±14.7 minutes, respectively. Other instructions in the WIs were followed in >75% of these patients. The Registered Nurse-to-patient care ratio was 1:1.5 (0.2-8.0). Nurses considered that to adjust manpower according to the varied numbers of patients during the day could improve their work. Nurses’ attitude to intravenous analgesic administration was positive. Conclusion: The overall PS was 4.1±2.7. Pain control system in Siriraj Hospital PACU was mostly in accordance with the hospital WIs, except that the time to re-evaluate the adequacy of analgesia was too long. Adjusting the manpower to suit the varying workload during the day was suggested to improve their work.

97-102

Authors: Kriangsak Sirirak, M.D.

A bed for burn wound care: a stainless steel grating-top table is used as a moveable sterilized table for burn wound cleansing or an operating table. Its top can be sterilized by autoclaving and after sterilization; burned patients can lie on this sterilized area for burn wound cleansing or surgical manipulation. The grating-top table can be moved room to room like a trolley by the wheel and its brake at each leg. In Prapokklao hospital, the grating-top table has been used for burn wound cleansing (using sterile solutions: warm saline, sterile water, and chlorhexidine scrub), and as an operating table when there is an indication for surgical manipulation. This study covered a total of 88 inpatients (during October 2009 - August 2012), and there were 213 times of wound cleansing (bathing and dressing) and 141 times of surgical manipulation (excision debridement and skin coverage operations). Follow with standard burn wound care principles: the grating-top table has been shown not only to be easy to use and comfortable for patients, but also results in less infection rate with good healing resulting in 86 success healing cases (97.73%) and 2 death cases (2.27%). The bed provides very cheap cost in burn wound care with appropriate outcomes.

113-119

Authors: Pornsuk Cheunsuchon, M.D., Atthanisa Punyashthira, M.D., Jantima Tanboon, M.D., Tumtip Sangruchi, M.D.

Objective: To describe accuracy, identify diagnostic discordances and pitfalls of intraoperative neuropathology diagnosis in Siriraj Hospital. Methods: All central nervous system lesions requested for rapid intraoperative consultation in Siriraj Hospital from 1998 to 2011 were reviewed. Accuracy rate and causes of diagnostic discrepancies were identi ed and discussed. Results: Intraoperative neuropathology consultation was performed in 774 cases during the study period. Non- representative specimens (40 cases, 5.2%) and cases with deferred diagnosis (36 cases, 4.7%) were excluded from the study. Of 698 cases analysed, 85.5% were neoplastic and 14.5% were non-neoplastic. The overall accuracy rate was 89%. In the neoplastic category, the most common pitfall was tumor type misclassi cation (66.7%) especially misclassi ed astrocytic and oligodendroglial tumors as other tumors (23.8%). In non-neoplastic category, the most common error was misdiagnosis of non-tumor pathology as gliomas (64.3%). Conclusion: Intraoperative neuropathology diagnosis has a crucial role in clinical management. Multidisciplinary and systematic approaches are required to overcome diagnostic limitations on small tissue samples and increase diagnostic accuracy.

127-130

Authors: Sakda Sathirareuangchai, M.D.

Sudden unexpected death is commonly dealt by a forensic pathologists. sudden cardiac death being a major cause of death in Thai population. Even though dilated cardiomyopathy is the most common type of car- diomyopathy found, it rarely results in sudden death. The author described a case of Thai adult male who was found dead in his bed. The autopsy nding revealed the cause of death to be dilated cardiomyopathy (DCM).